SEIZURE AND
EPILEPSY
PRESENTED BY ABDUL QADAR
BSN 4TH
KMU INS
OBJECTIVES
At the end of this lectures the students will be to
• Define seizure and epilepsy
• Identify the types, causes, and symptoms of seizures and
epilepsy
• Discuss diagnosis, treatment, and managements strategies
• Raise awareness and promote understanding of seizure and
epilepsy
EPILEPSY
• Epilepsy is a chronic non communicable
disease of the brain, characterized by
recurrent seizures, which are brief episodes
of involuntary movement that may involve a
part of the body (partial) or the entire body
(generalized) and are sometimes
accompanied by loss of consciousness and
control of bowel or bladder function.
SEIZURES
• Seizure episodes are a result of
excessive electrical discharges in a
group of brain cells.
• Seizures can vary from the briefest
lapses of attention or muscle jerks to
severe and prolonged convulsions.
TYPES OF SEIZURES
The international classification of seizures differentiates
into two main types
• Partial seizures that begin in one part of the brain
• Simple partial seizure, consciousness remains intact
• Complex partial seizure, consciousness is impaired
• Generalized seizures that involve electrical discharges in
the whole brain
• Unclassified seizures are so termed because of
incomplete data
CLINICAL MANIFESTATIONS
• Characteristics of seizures vary and depend on where in the
brain the disturbance first starts, and how far it spreads
• Temporary symptoms occur, such as loss of awareness or
consciousness
• Disturbance of movement, sensation (including vision,
hearing and taste), mood, or other cognitive functions.
• People with epilepsy tend to have more physical problems
(such as fractures and bruising from injuries related to
seizures), as well as higher rates of psychological conditions,
including anxiety and depression
• In simple partial seizures, only a finger or hand may
shake, or the mouth may jerk uncontrollably. The person
may talk unintelligibly; may be dizzy; and may
experience unusual or unpleasant sights, sounds, odors,
or tastes, but without loss of consciousness
• In complex partial seizures, the person either remains
motionless or moves automatically but inappropriately for
time and place, or he/she may experience excessive
emotions of fear, anger, elation, or irritability
• Generalized seizures, previously referred to as Grand mal
seizures, involve both hemispheres of the brain, causing
both sides of the body to react (Hickey, 2009). Intense
rigidity of the entire body may occur, followed by
alternating muscle relaxation and contraction
(generalized tonic–clonic contraction). The
simultaneous contractions of the diaphragm and chest
muscles may produce a characteristic epileptic cry.
• The tongue is often chewed, and the patient is
incontinent of urine and feces. After 1 or 2 minutes the
convulsive movements begin to subside; the patients
relaxes and lies in deep coma.
ETIOLOGY
• The causes of epilepsy are divided into the following
categories: structural, genetic, infectious, metabolic, immune
and unknown. Examples include:
• Brain damage from prenatal or perinatal causes (e.g. a loss of
oxygen or trauma during birth, low birth weight);
• Congenital abnormalities or genetic conditions with associated
brain malformations;
• Severe head injury;
• A stroke that restricts the amount of oxygen to the brain;
• An infection of the brain such as meningitis, encephalitis or
neurocysticercosis,
• Certain genetic syndromes
• Brain tumor
DIAGNOSIS
• Health history and Physical examination
• MRI is used to detect structural lesions such as focal
abnormalities, cerebrovascular abnormalities, and cerebral
degenerative change
• The EEG furnishes diagnostic evidence for a substantial
proportion of patients with epilepsy and assists in classifying the
type of seizure
• Telemetry and computerized equipment are used to monitor
electrical brain activity while the patient pursues his or her normal
activities and to store the readings on computer tapes for analysis
• SPECT useful for identifying the epileptogenic zone so that the
area in the brain giving rise to seizures can be removed surgically
• Video recording of seizures taken simultaneously with EEG
telemetry is useful in determining the type of seizure as well as its
duration and magnitude
TREATMENT
• Medication therapy controls rather than cures seizures.
• Anti-seizure (e.g. carbamazepine (Tegretol) clonazepam
(Klonopin))
• Barbiturates (e.g. clonazepam, diazpam)
• Bezodiapines (e.g. phenobarbital)
•
SURGERY
• When seizures are refractory to medication in adolescents
and adults with partial seizures, a generator may be
implanted under the clavicle. The device is connected to
the vagus nerve in the cervical area, where it delivers
electrical signals to the brain to control and reduce
seizure activites
• Temporal lobe resection
• Hemispherectomy
• Neuro Cybernetic Prosthesis (vagal nerve stimulator)
NURSING IMPLICATIONS
• Educate the patient about the importance of taking the drug
exactly as it is prescribed.
• All these drugs cause some degree of sedation, drowsiness, and
lethargy. Warn about driving or operating machinery when these
effects are significant.
• Advise not to drink alcohol or use other central nervous system
depressants.
• The patient should not stop taking an anticonvulsant abruptly
without consulting the provider.
• Check interactions with other drugs before administering any of
these drugs. Interaction with anticoagulants, oral contraceptives,
digoxin, aspirin, certain antibiotics, antacids, folic acid, and other
drugs are significant. Some anticonvulsant drugs interact with
each other (e.g. phenobarbital).
• Periodic blood work, every 1 to 3 months, should be performed
when taking an anticonvulsant. It may be used to check
therapeutic blood levels or organ dysfunction
• Dosages of each drug are based on therapeutic blood level
of the drug.
• Anticonvulsants have a narrow therapeutic range; toxicity
occurs if too much of the drug is taken
• The patient should be under the close supervision of the
health care provider.
• All of the anticonvulsant drugs can produce some unpleasant
side effects, such as fever and leukopenia and, in the case
of phenytoin, gingival hyperplasia and rash.
• Physical dependence can become a problem for patients
taking either phenobarbital or primidone, which is largely
converted to phenobarbital in the bloodstream
• Toxic side effects such as ataxia, drowsiness, nausea,
sedation, and dizziness are not uncommon
Raise Awareness On How To Manage
THANK YOU
